| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,141 |
2,969 |
$154K |
| D9450 |
|
3,904 |
2,904 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
3,417 |
3,265 |
$74K |
| D1120 |
Prophylaxis - child |
876 |
848 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,140 |
1,069 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,424 |
1,368 |
$37K |
| D2740 |
Crown - porcelain/ceramic |
22 |
13 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
201 |
146 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
797 |
718 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
248 |
231 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
70 |
50 |
$4K |
| D0272 |
Bitewings - two radiographic images |
148 |
140 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
73 |
68 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
31 |
27 |
$2K |